Chronic kidney disease is a condition in which your kidneys lose function over time. A diagnosis of end-stage kidney disease means that you’re in the final stage of chronic kidney disease and your kidneys are not functioning well enough to meet the needs of daily life. Your kidneys are responsible for filtering waste and excess water from your blood in the form of urine.
End-stage kidney disease is also referred to as end-stage renal disease (ESRD). If you have ESRD, your kidneys are functioning below 10 percent of their normal function. This may mean that your kidneys are barely functioning or not functioning at all. Kidney disease is usually progressive. Chronic kidney disease typically doesn’t reach the end stage until 10 to 20 years after you’re diagnosed. ESRD may also develop slowly.
Many types of kidney diseases attack the nephrons, which are the tiny units in the kidneys that do the filtering. This results in your blood not being filtered properly and eventually leads to ESRD.
Diabetes and high blood pressure, or hypertension, are the two most common causes of ESRD. If you have diabetes, your body can’t break down glucose, or sugar, correctly and glucose levels remain high in your blood. High levels of glucose in your blood damage your nephrons.
If you have hypertension, the increased pressure that’s forced upon the small vessels in your kidneys leads to damage. This damage prevents your blood vessels from performing their blood-filtering duties.
The two main groups at risk for ESRD are people with diabetes and those with hypertension. You are also more likely to develop the condition if you have relatives with the disease.
Your risk of developing ESRD also rises when you have any type of kidney disease or condition, including:
- polycystic kidney disease
- Alport syndrome
- interstitial nephritis
- certain autoimmune conditions, such as lupus
You may experience a wide range of symptoms. Common symptoms include:
- a decrease in how much you urinate
- an inability to urinate
- a general ill feeling
- unexplained weight loss
- a loss of appetite
- nausea and vomiting
- dry skin and itching
- changes in skin color
- bone pain
- confusion and difficulty concentrating
Other symptoms may include:
- bruising easily
- frequent nosebleeds
- numbness in your hands and feet
- bad breath
- excessive thirst
- frequent hiccups
- absence of menstrual cycles
- sleeping problems such as obstructive sleep apnea and restless leg syndrome (RLS)
- low libido or impotence
- swelling, or edema, especially in your legs and hands
Your doctor will diagnose ESRD through a physical examination and tests to check your kidney function. Kidney function tests your doctor may use include the following:
- A urinalysis is used to check for protein and blood in your urine. These are signs that your kidney isn’t processing waste properly.
- A serum creatinine test is used to check whether creatinine, a waste product your kidney filters out of your body, is building up in your blood.
- Blood urea nitrogen is used to check how much nitrogen is in your blood.
- The estimated glomerular filtration rate (GFR) estimates how well your kidneys are filtering waste.
The two treatments for ESRD are dialysis or a kidney transplant.
You have two options when you undergo dialysis.
One option is hemodialysis, which is a process that uses a machine to process your blood. It then filters out the waste using a solution and places the clean blood back into your body. This treatment method is usually used three times per week. It takes three to four hours each time.
Your doctor may also prescribe peritoneal dialysis, which involves placing a solution into your abdomen that’s later removed using a catheter.
Kidney transplant surgery involves removing your diseased kidneys and replacing them with a donated organ. One healthy kidney is all you need. This means that donors are often living because they can donate one and continue to function normally. According to the National Kidney Foundation, more than 17,000 kidney transplants were done in the United States in 2014.
Other Management Techniques
People with diabetes and those with hypertension should control their conditions in order to prevent ESRD. Both conditions benefit from drug therapy using angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).
A diet low in sodium, potassium, and other electrolytes may be needed, along with fluid restrictions. Caloric intake may need to be increased, and protein consumption may need to decrease.
Possible complications of ESRD include the following:
- skin infections from itching and dry skin
- hepatitis B
- hepatitis C
- liver failure
- heart and blood vessel problems
- a fluid buildup around your lungs
- an increased risk of infections
- nerve damage
- joint, bone, and muscle pain
- stomach and intestinal bleeding
- brain dysfunction and dementia
- abnormal electrolyte levels
- blood glucose level changes
- a weakening of your bones
- joint disorders
Advancements in treatments allow people with ESRD to live much longer than ever before. Treatment is crucial because without dialysis or a kidney transplant, ESRD can be life-threatening. The outcome of your treatment depends on you and your condition.
In some cases, ESRD isn’t preventable. However, you should keep your blood glucose levels and your blood pressure under control. You should always call a doctor if you have any ESRD symptoms. Early detection and treatment can delay or prevent the disease from progressing.